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A Strategic Turning Point for Healthcare payers

In another life I could have been Batman, but most days I settle for just being the designated human.

Under the Freedom of Information Act journalists from the Durdge Report discovered an email from the CEO of one of America’s largest health insurance companies to its employees regarding a change in their strategic direction in an attempt to reap benefits from the implementation of the Affordable Care Act.

It read in part:

“The other night my family and I were watching Warren Beatty’s movie, Heaven Can Wait in which Beatty, a former NFL quarterback, is reincarnated as a wealthy CEO, but one with a totally different personality. During the movie he is meeting with his board and listening to his customers complaining that the firm’s canned tuna subsidiary is killing a lot of porpoises in their fishing nets. Beatty replies to his board ‘Wouldn’t you pay more to save a fish that thinks? Let the other firms build plants in the wrong places, let the other quarterback throw a gurgle. Let’s be the team that makes the rules, that plays fair. It will cost us millions but we don’t care because we’ll come out ahead in the end.’

In my report to our board of directors I noted that there is an entire group of stakeholders that are not being served. It is not the group everyone is talking about and fighting over, the uninsured, it is the insured. It occurred to me that our greatest opportunity to grow our business has been right in front of our eyes the whole time.

Annually we spend millions of dollars employing thousands of people to adjudicate claims. Adjudicate is a polite word for deny. We have dozens of attorneys working around-the-clock drafting policy loopholes that allow us not to pay our customers’ claims. We are very, very good at what we do. But nobody likes us.

Accordingly, I have instructed our marketing department to design a new campaign around our new strategy. We are going to be the company that plays fair. We are going to let the other insurance companies kill the porpoises.

We are going to be the company that pays our customers’ claims. It will cost customers more, but they will actually get what they pay for. It will cost us millions but we don’t care because we’ll come out ahead in the end.”

When you live in a house of mirrors or fall through the looking glass, the impossible becomes possible. On my best days I try to solve three or four impossible things before breakfast. This problem, even when viewed from the land of fantasy does not appear to have a solution.